Complex Anorectal Fistulas: A Critical Review of Evolving Surgical Techniques, Continence Preservation, And Recurrence Dynamics

Complex anorectal fistulas remains a formidable challenge, And choosing the best surgical approach that will drastically improve the patient's condition and reduce the risk of incontinence remains unclear, requiring a delicate balance between eradicating the infected tract and preserving fecal continence. This critical review assesses the current sphincter-sparing surgical instruments and the method's theoretical origins, success rates and complications. This review includes all available clinical studies, meta-analyses, and guidelines regarding LIFT, TROPIS, ERAF, FiLaC, VAAFT, and biologic therapy. The traditional sphincter-sparing methods differ. For LIFT they are proven successful for 60%-76%, but because the lateral tract is recovered it is considered that the TROPIS is a better procedure (primary healing rate of 85%-94%) which focuses on ISTAC and DRAPED. The least invasive thermal and endoscopic therapies ensure continuation but show higher recurrence rates (20%-43%). When intersphincteric sepsis is treated and external anal sphincter is kept out of the picture, the most durable results are available. The TROPIS is a paradigm change, from modern management perspective.